REAL LIFE SAFETY

A near miss is as good as a win. Please share your experience even if an accident was averted. Why? Because we are all in this
together. Regardless of whether the incident was major or minor, a single occurrence or something you see every day—
letting someone know could save someone’s life or health.

* Required

1
YOUR CONTACT INFORMATION

Title

First Name *

Last Name *

Email Address *

Company *

Work Address *

City *

State *

Zipcode/Postcode *

Country *

2
THE SITUATION

What industry do you work in (ie, construction, glass processing, recycling, warehouse, septic)?

Describe the protective products you were using at the time of the incident: